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Traumacare: son of ACA
Speakers gathered to talk about how the future of the Affordable Care Act may impact Oregon business.
Unlike Measure 97, the corporate tax, the Portland Business Alliance is staying neutral on the issue of the repeal of the Affordable Care Act.
Since the ACA was implemented, the uninsured rate in Oregon has gone down 59 percent, with half a million Oregonians gaining insurance in six years.
But Governor Brown says the costs of Medicaid expansion under the ACA will account for over 60 percent of the $1.8 billion budget deficit in the coming 2017-19 biennium, having a significant effect on the economy.
One thing was certain: they don't expect quick progress. Asked how far a replacement of the ACA will have progressed in one year's time, all four experts estimated between thee and four on a scale of one to 10.
According to Eric Hunter, President & CEO, CareOregon, an issue that cannot be ignored is the amount of Federal money flowing into Oregon for the expansion for Medicaid. "The Federal government is still paying 95 percent of those costs. The state is paying $350 million to $370 million while the the total influx of cash coming into the economy of the state is $4 billion."
Hunter says the Kaiser Family Foundation estimates that 43,000 Oregon jobs are pegged to the Affordable Care Act. "Just the income taxes for those jobs covers the expense on the state side, and will not be allowed to impact the state budget, so we need to make sure we don't cut off our nose to spite our face."
"Governor Brown says she does not want to decrease eligibility and decrease benefits, but we're going to have to pay for that."
He reminded everyone that Oregon didn't reach its goals by using the existing Medicaid fund. It was granted $1.9 billion dollars by the Federal government to innovate, money that is not coming again. "They have to keep doing those creative things around housing and food insecurity and those things that drive the long term care needs..." The prospect of doing without that money as a budget cutting exercise is "scary."
Bruce Howell, Healthcare Industry Group Leader, Schwabe, Williamson & Wyatt, noted that at town halls across the U.S., constituents are showing their anger at "the very conservative wing of the Republican party's hopes to repeal the ACA." However, he added, "The American healthcare industry is unique to the world, and very complex. There's lots of whack-a-mole — things that pop up in expected places." He said the best hope is to "learn how to put it all together so we can move forward."
He added his opinion that the law is poorly written.
K. John McConnell, Health Economist & Director of the Center for Health Systems Effectiveness, Oregon Health & Science University, cautioned that it took from 2010 to 2014 to get Obamacare in effect, so don't expect much of a replacement to happen in the next two or three years. "The Republicans recognize it's not a quick fix," he said.
Talking of Republicans, Hunter of CareOregon said Rep. Greg Walden is in a tough spot. Some of his constituents are part of the "repeal, and the numbers of uncovered be damned" group. Others could be victims of the economic impact: "He wants to keep the no previous conditions part of it. But can you have the guarantees if you have continuous eligibility and don't drop off the plan?" Again, Hunter couldn't see much happening in the next year.
Kraig Anderson joked that he was looking forward to the best of Obamacare and Trumpcare, "which will be called Traumacare."
The U.S. puts a lot of its healthcare money into technology compared to Europe, where more money is spent on primary care, establishing a connection with a physician. The panel has seen that companies with more than 100 employees have quite a bit of control over their premiums, and they are tending towards preventive care. They work on prevention and managing chronic illness, and many are trying to establish a culture of activity — bike commuting, fun runs and healthy lunchrooms. They can also encourage employees to buy cheaper generic over branded medications.
Anderson, the Moda Health actuary, said that the mandate didn't impact employers with less than 50 employees, so there would not be much change there. Even for those with over 50, the law only affected them in terms of making them do additional reporting. Also, the tax credit take up was smaller than expected: Less than $200,000 instead of $1.4 million per year.
Everyone agreed that with federal funding for Medicaid being cut, then in 10 to 15 years it will be underfunded and that will affect the economy.
Healthcare is always citied as one of Oregon's biggest sectors, and the disappearance of a large proportion of those jobs could be hard on the local economy.
In Salem, Eric Hunter of CareOregon said that there is genuine interest in fixing the budget gap, and even talk of raising revenue with a "Son of 97 (Measure 97) revenue enhancement with help from business."
Asked what resources they recommend for tracking the progress of the health care and health insurance industries, the panelists answered variously, read the New York Times, hire a consultant, and talk to the producers, agents and brokers.
OHSU's K. John McConnell reminded everyone that one in four Oregonians is covered by Medicaid, and that Oregon has one of the best Medicaid programs in the country — ranked number one by a Harvard economist.
Business support for ACA
The Main Street Alliance of Oregon represents business owners and employees with a progressive angle. That is, they don't just lobby for deregulation and lowering taxes. Its mission is to "elevate the voices of small business owners on important public policy issues in Oregon."
In a study of their own members they found great support for the Affordable Care Act.
"There is still no clear replacement plan that matches the ACA's record of providing quality care at a lower cost for more people, and no plan that ensures the ACA's protections against gender discrimination and pre-existing conditions remain in place," read the report, which comes out Feb. 23.
"Yet lawmakers in Washington, D.C. continue to move forward with repeal efforts, seemingly without regard for the impact on communities."
Shaun Sieren, owner of O'Neill Public House, says that he was uninsured for years until the Affordable Care Act. "I'm 45 now so I'm at the ragged edge of needing insurance," Sieren told the Business Tribune. But he and "a good chunk of" his employees have come to rely on insurance bought in the ACA exchange. Most of the 13 staff are bartenders, servers and cooks.
His business is part of the community and he cares about his employees. "We are doing what we can to keep the doors open, and the Main Street Alliance has been a help." He has been to Washington D.C. recently to lobby with the group, and is raising his voice again to save the Affordable Care Act.
Sieren says he can't recall the insurer's name or what level of plan he has, since the deductible is too high to be worth using. But he likes having it for what it is: insurance.
"I have a couple of staff who use it for their kids and others who are worried about preexisting conditions."